Additional Information
Book Details
Abstract
Develop the understanding and clinical reasoning skills you’ll need to confidently manage dysphagia in professional practice! This logically organized, evidence-based resource reflects the latest advancements in dysphagia in an approachable, student-friendly manner to help you master the clinical evaluation and diagnostic decision-making processes. Realistic case scenarios, detailed review questions, and up-to-date coverage of current testing procedures and issues in pediatric development prepare you for the conditions you’ll face in the clinical setting and provide an unparalleled foundation for professional success.
- Comprehensive coverage addresses the full spectrum of dysphagia to strengthen your clinical evaluation and diagnostic decision-making skills.
- Logical, user-friendly organization incorporates chapter outlines, learning objectives, case histories, and chapter summaries to reinforce understanding and create a more efficient learning experience.
- Clinically relevant case examples and critical thinking questions throughout the text help you prepare for the clinical setting and strengthen your decision-making skills.
- Companion Evolve Resources website clarifies key diagnostic procedures with detailed video clips.
Table of Contents
| Section Title | Page | Action | Price |
|---|---|---|---|
| Front cover | cover | ||
| Half title page | i | ||
| Evolve | ii | ||
| Dysphagia: Clinical Management in Adults and Children | iii | ||
| Copyright page | iv | ||
| Contributors | v | ||
| Dedication | vi | ||
| Preface | ix | ||
| Table of Contents | xi | ||
| 1 Foundations | 1 | ||
| 1 Dysphagia Unplugged | 1 | ||
| CHAPTER OUTLINE | 1 | ||
| OBJECTIVES | 1 | ||
| WHAT IS DYSPHAGIA? | 2 | ||
| INCIDENCE AND PREVALENCE | 4 | ||
| Prevalence by Setting | 5 | ||
| Community | 5 | ||
| Acute and Chronic Geriatric Care | 5 | ||
| Acute General Hospitals | 5 | ||
| Acute Rehabilitation Unit | 5 | ||
| Special Populations | 5 | ||
| Stroke. | 5 | ||
| Head/Neck Cancer. | 6 | ||
| Head Injury. | 6 | ||
| Progressive Neurologic Disease. | 6 | ||
| Parkinson’s Disease. Although dysphagia secondary to Parkinson’s disease appears to be common, accurate measurements are restricted by subject selection bias and dysphagia detection methods. However, most authors agree that dysphagia occurs in at least 50% of patients with Parkinson’s disease.32-34 In 72 patients with Parkinson’s disease of varying severity, Leopold and Kagel35 found that as many as 82% reported swallowing difficulty. The prevalence of dysphagia may be higher in patients with Parkinson’s disease who also have significant dementia.36 | 6 | ||
| Parkinson’s Disease. | 6 | ||
| Amyotropic Lateral Sclerosis. | 7 | ||
| Multiple Sclerosis. | 7 | ||
| Myasthenia Gravis. | 7 | ||
| Muscular Dystrophy. | 7 | ||
| Polymyositis and Dermatomyositis. | 7 | ||
| Rheumatoid Arthritis. | 7 | ||
| Scleroderma. | 7 | ||
| Sjögren’s Syndrome. | 7 | ||
| Premature Infants. | 7 | ||
| CONSEQUENCES OF DYSPHAGIA | 7 | ||
| Medical Consequences | 7 | ||
| Psychosocial Consequences | 8 | ||
| Clinical Management | 8 | ||
| Clinical Examination | 9 | ||
| Instrumental Examination | 9 | ||
| Treatment Options | 9 | ||
| WHO MANAGES DYSPHAGIA? | 10 | ||
| Speech-Language Pathologist | 10 | ||
| Otolaryngologist | 11 | ||
| Gastroenterologist | 11 | ||
| Radiologist | 12 | ||
| Neurologist | 12 | ||
| Dentist | 12 | ||
| Nurse | 12 | ||
| Dietitian | 12 | ||
| Occupational Therapist | 12 | ||
| Neurodevelopmental Specialist | 12 | ||
| Pulmonologist/Respiratory Therapist | 13 | ||
| LEVELS OF CARE | 13 | ||
| Acute Care Setting | 13 | ||
| Neonatal Care Unit | 14 | ||
| Subacute Care Setting | 14 | ||
| Rehabilitation Setting | 14 | ||
| Skilled Nursing Facility | 14 | ||
| Home Health | 15 | ||
| TAKE HOME NOTES | 16 | ||
| References | 16 | ||
| 2 Normal Swallowing in Adults | 19 | ||
| CHAPTER OUTLINE | 19 | ||
| OBJECTIVES | 19 | ||
| NORMAL ANATOMY | 20 | ||
| Oral Preparatory Stage | 20 | ||
| Oral/Pharyngeal Stage | 22 | ||
| Esophageal Stage | 25 | ||
| NORMAL PHYSIOLOGY | 25 | ||
| Oral Preparation | 26 | ||
| Oral Stage | 27 | ||
| Respiration and Swallow | 28 | ||
| Pharyngeal Stage | 28 | ||
| Esophageal Stage | 29 | ||
| BOLUS AND DELIVERY VARIATION | 30 | ||
| Volume and Biomechanics | 31 | ||
| Viscosity | 32 | ||
| SWALLOW AND NORMAL AGING | 32 | ||
| Oral Stage and Aging | 33 | ||
| Pharyngeal Stage and Aging | 33 | ||
| Esophagus and Aging | 34 | ||
| NEUROLOGIC CONTROLS OF SWALLOWING | 34 | ||
| Peripheral and Medullary Controls | 34 | ||
| Supranuclear Swallowing Controls | 38 | ||
| TAKE HOME NOTES | 39 | ||
| References | 39 | ||
| 3 Normal Swallowing and Development in the Term and Preterm Infant | 43 | ||
| CHAPTER OUTLINE | 43 | ||
| OBJECTIVES | 43 | ||
| EMBRYOLOGY AND FETAL DEVELOPMENT | 44 | ||
| NORMAL DEVELOPMENTAL MILESTONES | 45 | ||
| Auditory Development | 45 | ||
| Visual Development | 45 | ||
| Development of Taste and Smell | 45 | ||
| Motor Reflex Development | 46 | ||
| NORMAL INFANT SWALLOWING | 46 | ||
| Normal Anatomy | 46 | ||
| Nonnutritive and Nutritive Sucking | 47 | ||
| Suckle Versus Sucking | 47 | ||
| Breastfeeding | 47 | ||
| Early Infancy | 48 | ||
| Transitional Feeding | 48 | ||
| Six to Twelve Months | 48 | ||
| TAKE HOME NOTES | 48 | ||
| References | 49 | ||
| 2 Causes and Characteristics of Dysphagia | 50 | ||
| 4 Disorders in Infants and Children | 50 | ||
| CHAPTER OUTLINE | 50 | ||
| OBJECTIVES | 50 | ||
| INFANT BACKGROUND | 51 | ||
| MATERNAL CONDITIONS | 51 | ||
| Diabetes and Gestational Diabetes | 51 | ||
| Preeclampsia | 51 | ||
| Drugs | 51 | ||
| PREMATURITY | 51 | ||
| Necrotizing Enterocolitis | 52 | ||
| Gastroesophageal Reflux Disease | 52 | ||
| Tracheoesophageal Fistula and Atresia | 52 | ||
| RESPIRATORY DISORDERS | 52 | ||
| Respiratory Distress Syndrome | 53 | ||
| Transient Tachypnea of the Newborn | 53 | ||
| Apnea | 53 | ||
| Bronchopulmonary Dysplasia | 53 | ||
| Persistent Pulmonary Hypertension in the Newborn | 54 | ||
| NEUROLOGIC DISORDERS | 54 | ||
| Microcephaly | 54 | ||
| Hydrocephalus | 54 | ||
| Intracranial Hemorrhage | 54 | ||
| Seizures | 55 | ||
| Periventricular Leukomalacia | 55 | ||
| Birth Injuries | 55 | ||
| CARDIOVASCULAR DISORDERS | 55 | ||
| CONGENITAL ANOMALIES | 55 | ||
| Cleft Lip and Cleft Palate | 55 | ||
| PEDIATRIC FEEDING DISORDERS | 56 | ||
| TYPICAL DEVELOPMENT: INFANT TO CHILD | 57 | ||
| MEDICAL IMPACT ON FEEDING | 65 | ||
| Gastrointestinal Disorders | 65 | ||
| Eosinophilic Esophagitis | 66 | ||
| Celiac Disease | 66 | ||
| Other Disorders | 66 | ||
| Cardiac and Respiratory Conditions | 66 | ||
| Disorders of the Head and Neck | 66 | ||
| Allergies | 67 | ||
| SENSORY IMPACT ON FEEDING | 67 | ||
| AUTISM SPECTRUM DISORDERS | 68 | ||
| CEREBRAL PALSY | 68 | ||
| BRAIN INJURY | 69 | ||
| DOWN SYNDROME | 69 | ||
| TAKE HOME NOTES | 69 | ||
| References | 70 | ||
| 5 Adult Neurologic Disorders | 72 | ||
| CHAPTER OUTLINE | 72 | ||
| OBJECTIVES | 72 | ||
| PRELIMINARY CONSIDERATIONS: SWALLOWING SYMPTOMS AND NEUROLOGIC DEFICITS | 73 | ||
| Brief Overview of Functional Neuroanatomy Relative to Swallowing Functions | 73 | ||
| CORTICAL FUNCTIONS | 73 | ||
| Cortical Functions and Swallowing Impairment | 74 | ||
| Issues of Unilateral versus Bilateral Hemispheric Lesions | 75 | ||
| SWALLOWING DEFICITS IN HEMISPHERIC STROKE SYNDROMES | 76 | ||
| Treatment Considerations | 79 | ||
| SWALLOWING DEFICITS IN DEMENTIA | 80 | ||
| Treatment Considerations | 82 | ||
| SWALLOWING DEFICITS IN TRAUMATIC BRAIN INJURY | 83 | ||
| Treatment Considerations | 84 | ||
| SUBCORTICAL FUNCTIONS | 84 | ||
| SUBCORTICAL FUNCTIONS AND SWALLOWING IMPAIRMENT: PARKINSON’S DISEASE | 84 | ||
| Treatment Considerations | 85 | ||
| BRAINSTEM FUNCTIONS | 86 | ||
| Brainstem Functions and Swallowing Impairment | 87 | ||
| Treatment Considerations | 88 | ||
| The Role of the Cerebellum in Swallowing | 88 | ||
| LOWER MOTOR NEURON AND MUSCLE DISEASE | 88 | ||
| Lower Motor Neuron Functions and Swallowing Impairment | 89 | ||
| Muscle Diseases and Swallowing Impairment | 90 | ||
| Polyneuropathy | 90 | ||
| Myasthenia Gravis | 91 | ||
| Polymyositis, Scleroderma, and Systemic Lupus Erythematosus | 91 | ||
| Muscular Dystrophy | 92 | ||
| Treatment Considerations | 92 | ||
| IDIOPATHIC OR IATROGENIC DISORDERS OF SWALLOWING THAT RESEMBLE NEUROGENIC DYSPHAGIA | 92 | ||
| TAKE HOME NOTES | 93 | ||
| References | 94 | ||
| 6 Dysphagia and Head/Neck Cancer | 99 | ||
| CHAPTER OUTLINE | 99 | ||
| OBJECTIVES | 99 | ||
| CANCER AS A DISEASE | 100 | ||
| What Is Cancer? | 100 | ||
| Diagnosis of Cancer | 101 | ||
| Staging | 101 | ||
| TREATMENTS FOR HEAD/NECK CANCERS | 102 | ||
| Surgery | 103 | ||
| Radiation Therapy | 105 | ||
| Chemotherapy | 105 | ||
| DYSPHAGIA IN PATIENTS WITH HEAD/NECK CANCER | 106 | ||
| Dysphagia from Surgical Intervention | 106 | ||
| Surgery for Oral Cancers | 106 | ||
| Surgery for Oropharyngeal Cancers | 107 | ||
| Surgery for Hypopharyngeal Cancers | 108 | ||
| Surgery for Laryngeal Cancers | 108 | ||
| Dysphagia from Radiation Therapy | 109 | ||
| Dysphagia Characteristics after Radiation Therapy | 110 | ||
| ASSESSMENT STRATEGIES FOR DYSPHAGIA IN HEAD/NECK CANCER | 113 | ||
| Timing of Swallow Evaluations | 113 | ||
| Assessing Impact Factors | 113 | ||
| THERAPY STRATEGIES FOR DYSPHAGIA IN HEAD/NECK CANCER | 116 | ||
| Timing of Swallowing Therapy | 116 | ||
| Therapy for Bolus Transport Problems | 117 | ||
| Therapy for Airway Protection Problems | 118 | ||
| Therapies for Mucosal and Muscle Changes Resulting from Radiation Therapy | 120 | ||
| TAKE HOME NOTES | 121 | ||
| References | 122 | ||
| 7 Esophageal Disorders | 126 | ||
| CHAPTER OUTLINE | 126 | ||
| OBJECTIVES | 126 | ||
| ROLE OF THE SPEECH-LANGUAGE PATHOLOGIST | 127 | ||
| STRUCTURAL DISORDERS | 127 | ||
| Esophageal Stenosis | 127 | ||
| Rings and Webs | 128 | ||
| Benign Stricture | 129 | ||
| Malignant Stricture | 130 | ||
| Luminal Deformities | 132 | ||
| Extrinsic Compression | 132 | ||
| Esophageal Diverticulum | 132 | ||
| ESOPHAGEAL MOTILITY DISORDERS | 132 | ||
| Disorders of Peristalsis | 132 | ||
| Diffuse Esophageal Spasm | 133 | ||
| Nutcracker Esophagus | 133 | ||
| Nonspecific Motility Disorders | 134 | ||
| Treatment of Motility Disorders | 134 | ||
| LOWER ESOPHAGEAL SPHINCTER ABNORMALITIES | 135 | ||
| Achalasia | 135 | ||
| Isolated Abnormalities of the Lower Esophageal Sphincter | 136 | ||
| Motor Weakness | 136 | ||
| GASTROESOPHAGEAL REFLUX DISEASE | 136 | ||
| Mechanisms of Reflux | 137 | ||
| Measuring Reflux | 137 | ||
| Treatment of Gastroesophageal Reflux Disease | 138 | ||
| LARYNGOPHARYnGEAL REFLUX | 138 | ||
| DIFFERENTIAL DIAGNOSIS | 139 | ||
| DISORDERS OF THE PHARYNGOESOPHAGEAL SEGMENT | 139 | ||
| Cricopharyngeal Bar | 139 | ||
| Zenker’s Diverticulum | 140 | ||
| PHARYNGOESOPHAGEAL RELATIONS | 142 | ||
| TAKE HOME NOTES | 143 | ||
| References | 143 | ||
| 8 Respiratory and Iatrogenic Disorders | 146 | ||
| CHAPTER OUTLINE | 146 | ||
| OBJECTIVES | 146 | ||
| BACKGROUND | 147 | ||
| ARTIFICIAL AIRWAYS | 147 | ||
| Endotracheal Tubes | 147 | ||
| Tracheotomy Tubes | 148 | ||
| SWALLOWING AND TRACHEOSTOMY | 149 | ||
| Laryngeal Elevation | 150 | ||
| Restoring Subglottic Pressure | 150 | ||
| POSTSURGICAL CAUSES OF DYSPHAGIA | 151 | ||
| Thyroidectomy | 151 | ||
| Carotid Endarterectomy | 152 | ||
| Cervical Spine Procedures | 152 | ||
| Esophagectomy | 153 | ||
| Skull Base/Posterior Fossa | 155 | ||
| TRAUMATIC INJURIES | 155 | ||
| Dental Trauma | 156 | ||
| Thermal Burn Trauma | 156 | ||
| MEDICATIONS | 156 | ||
| CHRONIC OBSTRUCTIVE PULMONARY DISEASE | 158 | ||
| TAKE HOME NOTES | 159 | ||
| References | 159 | ||
| 3 Evaluation of Swallowing | 162 | ||
| 9 Clinical Evaluation of Adults | 162 | ||
| CHAPTER OUTLINE | 162 | ||
| OBJECTIVES | 162 | ||
| RATIONALE | 163 | ||
| SYMPTOMS OF DYSPHAGIA | 164 | ||
| Patient Description | 164 | ||
| Obstruction | 165 | ||
| Liquids Versus Solids | 167 | ||
| Gastroesophageal Reflux | 167 | ||
| Eating Habits | 167 | ||
| SIGNS OF DYSPHAGIA | 168 | ||
| MEDICAL HISTORY | 168 | ||
| Historical Variables | 168 | ||
| Congenital Disease | 168 | ||
| Neurologic Disease | 171 | ||
| Surgical Procedures | 171 | ||
| Systemic and Metabolic Disorders | 171 | ||
| Respiratory Impairment | 171 | ||
| Esophageal Disease | 172 | ||
| Previous Test Results | 172 | ||
| Advance Directive | 172 | ||
| PHYSICAL EXAMINATION | 172 | ||
| Clinical Observations | 172 | ||
| Feeding Tubes | 172 | ||
| Tracheotomy Tubes | 173 | ||
| Respiratory Pattern | 173 | ||
| Mental Status | 174 | ||
| Cranial Nerve Examination | 175 | ||
| Facial Muscles | 175 | ||
| Muscles of Mastication | 175 | ||
| Pathologic Reflexes | 176 | ||
| Tongue Musculature | 176 | ||
| Oral Cavity | 176 | ||
| Oropharynx | 177 | ||
| Pharynx | 177 | ||
| Larynx | 178 | ||
| Test Swallows | 178 | ||
| Feeding Evaluation | 180 | ||
| Environment | 181 | ||
| Feeding | 181 | ||
| Posture | 181 | ||
| Eating | 181 | ||
| Assistance | 182 | ||
| TESTS TO DETECT ASPIRATION | 182 | ||
| Water Tests | 183 | ||
| Oxygen Saturation Tests | 184 | ||
| Modified Evans Blue Dye Test | 184 | ||
| STANDARDIZED TESTS | 185 | ||
| SUPPLEMENTAL TESTS | 186 | ||
| TAKE HOME NOTES | 188 | ||
| References | 188 | ||
| 10 Instrumental Swallowing Examinations: | 191 | ||
| CHAPTER OUTLINE | 191 | ||
| OBJECTIVES | 191 | ||
| CONSIDERATIONS FOR AN INSTRUMENTAL SWALLOWING EXAMINATION | 192 | ||
| Goals of Instrumental Swallowing Evaluations | 192 | ||
| Purposes of Instrumental Swallowing Examinations | 192 | ||
| Indications for Instrumental Swallowing Examinations | 193 | ||
| VIDEOFLUOROSCOPIC SWALLOWING EXAMINATIONS | 194 | ||
| What’s in a Name? | 194 | ||
| Objectives of the Videofluoroscopic Swallowing Examination | 195 | ||
| Procedures for the Videofluoroscopic Swallowing Examination | 196 | ||
| Patient Positioning | 196 | ||
| Material Used in the Fluoroscopic Study | 197 | ||
| Sequencing the Events in the Fluoroscopic Study | 198 | ||
| What to Look For | 199 | ||
| Strengths and Weaknesses of the Fluoroscopic Swallowing Study | 202 | ||
| ENDOSCOPIC SWALLOWING EXAMINATIONs | 203 | ||
| Differences Between the Endoscopic Swallowing Examination and the Fluoroscopic Swallowing Examination | 203 | ||
| Similarities | 203 | ||
| Differences | 204 | ||
| Procedures for the Endoscopic Swallowing Study | 205 | ||
| What to Look For | 207 | ||
| Strengths and Weakness of the Endoscopic Swallowing Study | 208 | ||
| DIRECT COMPARISONS BETWEEN FLUOROSCOPIC AND ENDOSCOPIC SWALLOWING EXAMINATIONS | 209 | ||
| TAKE HOME NOTES | 210 | ||
| References | 212 | ||
| 11 Special Considerations in Evaluating Infants and Children | 215 | ||
| CHAPTER OUTLINE | 215 | ||
| OBJECTIVES | 215 | ||
| INFANTS | 216 | ||
| INFANT SUBSYSTEMS | 216 | ||
| Physiologic Support Systems | 216 | ||
| Motor System | 216 | ||
| State System | 216 | ||
| Attention System | 217 | ||
| Self-Regulatory System | 217 | ||
| DEVELOPMENTAL STAGES | 217 | ||
| BEDSIDE DEVELOPMENTAL and/or FEEDING EVALUATION | 217 | ||
| History | 217 | ||
| State Systems | 218 | ||
| Posture and Tone | 218 | ||
| Reflexes | 218 | ||
| Adaptive Responses | 218 | ||
| Physiologic Stability | 218 | ||
| Oral Reflexes | 218 | ||
| Nonnutritive Suck | 219 | ||
| Nutritive Suck | 219 | ||
| INSTRUMENTAL EVALUATION | 219 | ||
| Videofluoroscopic Swallowing Study | 219 | ||
| Videofluoroscopic Swallowing Study and Upper Gastrointestinal Series | 220 | ||
| Fiberoptic Endoscopic Evaluation | 220 | ||
| OLDER CHILDREN | 220 | ||
| CLINICAL FEEDING EVALUATION | 221 | ||
| Preparing for the Evaluation | 221 | ||
| CASE HISTORY | 222 | ||
| PREFEEDING ACTIVITIES | 223 | ||
| TECHNICAL ASPECTS | 224 | ||
| Examining Oral Structure and Function | 225 | ||
| OBSERVATION OF THE FEEDING PROCESS | 226 | ||
| Liquids | 226 | ||
| Foods | 226 | ||
| SPECIAL CONSIDERATIONS for THE INFANT | 226 | ||
| SPECIAL CONSIDERATIONS FOR THE TODDLER | 226 | ||
| Solid Foods | 226 | ||
| Food Types | 227 | ||
| SPECIAL CONSIDERATIONS FOR THE OLDER CHILD | 227 | ||
| SHARING THE RESULTS | 227 | ||
| TAKE HOME NOTES | 229 | ||
| References | 229 | ||
| 4 Approaches to Treatment | 231 | ||
| 12 Treatment Considerations, Options, and Decisions | 231 | ||
| CHAPTER OUTLINE | 231 | ||
| OBJECTIVES | 231 | ||
| EVIDENCE-BASED PRACTICE | 232 | ||
| EVALUATING EVIDENCE | 232 | ||
| GENERAL TREATMENT CONSIDERATIONS | 234 | ||
| PATIENT-SPECIFIC TREATMENT | 236 | ||
| APPROACH-SPECIFIC TREATMENT | 237 | ||
| Treatment Choices | 237 | ||
| OVERVIEW OF TREATMENT OPTIONS | 238 | ||
| Medical Options | 238 | ||
| Surgical Options | 239 | ||
| Improving Glottal Closure | 239 | ||
| Protecting the Airway | 240 | ||
| Improving Pharyngoesophageal Segment Opening | 240 | ||
| Behavioral Options | 241 | ||
| Food Modifications | 241 | ||
| Rheology. | 241 | ||
| Volume. | 242 | ||
| Temperature. | 242 | ||
| Taste and Smell. | 242 | ||
| Modify Feeding Activity | 242 | ||
| Patient Modifications | 244 | ||
| Mechanism Modifications | 244 | ||
| Swallow Modifications | 244 | ||
| MAKING TREATMENT DECISIONS | 244 | ||
| Sources of Information | 245 | ||
| Forming Meaningful Questions | 245 | ||
| Planning Individual Therapy | 246 | ||
| FRAMEWORK FOR TREATMENT PLANNING | 247 | ||
| TAKE HOME NOTES | 251 | ||
| References | 251 | ||
| 13 Treatment for Infants and Children | 253 | ||
| CHAPTER OUTLINE | 253 | ||
| OBJECTIVES | 253 | ||
| FOSTERING STABILITY AND ORGANIZATION | 254 | ||
| Developmental Supportive Care | 254 | ||
| Positioning | 254 | ||
| Skin-to-Skin Care | 254 | ||
| Co-bedding | 255 | ||
| READINESS TO EAT | 255 | ||
| PACIFIERS, BOTTLES, AND NIPPLES | 256 | ||
| FEEDING POSITIONING | 257 | ||
| ORAL SENSORY AND FACIAL STIMULATION | 257 | ||
| CUE-BASED FEEDING SCHEDULE | 257 | ||
| THEORIES OF FEEDING TREATMENT | 257 | ||
| Sequential Oral Sensory Approach | 257 | ||
| Structured Behavioral Feeding Approach | 260 | ||
| Beckman Oral Motor Approach | 260 | ||
| MODELS OF THERAPY | 260 | ||
| Individual Therapy | 261 | ||
| Group Therapy | 261 | ||
| Intensive Day Treatment | 261 | ||
| FAMILY-FRIENDLY GOALS | 261 | ||
| SHORT-TERM GOALS | 262 | ||
| Cultural Considerations | 262 | ||
| DEVELOPING A CARE PLAN | 262 | ||
| Preparing the Child for Eating | 263 | ||
| Introducing New Foods | 263 | ||
| Matching Skills with Texture and Taste | 264 | ||
| Changing Taste and Texture | 265 | ||
| Meltable Solids | 265 | ||
| Hard Munchables | 265 | ||
| Therapy Guidelines | 265 | ||
| Choosing Utensils | 267 | ||
| Mouth Opening (Size and Range) | 267 | ||
| Sucking Strength | 267 | ||
| Swallowing Skills | 268 | ||
| Age | 268 | ||
| Reinforcement | 268 | ||
| TUBE FEEDING | 269 | ||
| TAKE HOME NOTES | 270 | ||
| References | 271 | ||
| Appendix 13-A Food Diary For _____________________________ | 273 | ||
| Appendix 13-B Useful Resources Of Materials And Contact Information For Treatment Of Children With Feeding Disorders | 274 | ||
| 14 Treatment for Adults | 275 | ||
| CHAPTER OUTLINE | 275 | ||
| OBJECTIVES | 275 | ||
| WHICH TECHNIQUES AND WHAT TO CONSIDER | 276 | ||
| MANAGING DYSPHAGIA SYMPTOMS: ADJUSTMENTS, COMPENSATIONS, AND MODIFICATIONS | 276 | ||
| General Postural Adjustments | 276 | ||
| Head Postural Adjustments | 278 | ||
| Head Extension | 278 | ||
| Head Flexion–Chin Tuck | 278 | ||
| Head Rotation–Head Turn | 279 | ||
| Thickening Liquids and Modifying Diets | 281 | ||
| Thickened Liquids: Pros and Cons | 281 | ||
| Additional Impact of Thickened Liquids on the Swallow Mechanism. | 282 | ||
| Other Liquid Modifications | 283 | ||
| Texture-Modified Diets | 284 | ||
| CHANGING THE SWALLOW: ACTIVE THERAPY TECHNIQUES | 285 | ||
| Improving the Mechanism: Oral Motor Exercises | 285 | ||
| PROTECTING THE AIRWAY: BREATH HOLD AND SUPRAGLOTTIC AND SUPER-SUPRAGLOTTIC SWALLOWS | 286 | ||
| Prolonging the Swallow: The Mendelsohn Maneuver | 288 | ||
| Increasing Force: The Effortful Swallow | 290 | ||
| Additional Techniques to Change the Swallow | 292 | ||
| Multiple Swallows as a Therapy Technique | 292 | ||
| The Tongue-Hold Maneuver | 293 | ||
| The Head-Lift Exercise | 295 | ||
| Thermal-Tactile Application | 295 | ||
| NEW DIRECTIONS: EXERCISE PRINCIPLES AND MODALITIES | 296 | ||
| Exercise Principles and Dysphagia Therapy | 297 | ||
| What Do Adjunctive Modalities Offer the Patient? | 298 | ||
| Surface Electromyographic and Other Forms of Biofeedback | 298 | ||
| Neuromuscular Electrical Stimulation | 299 | ||
| Potential Future Directions | 300 | ||
| FINAL COMMENTS ON USING EVIDENCE | 300 | ||
| TAKE HOME NOTES | 301 | ||
| References | 302 | ||
| 15 Ethical Considerations | 308 | ||
| CHAPTER OUTLINE | 308 | ||
| CHAPTER OBJECTIVES | 308 | ||
| MEDICAL ETHICS | 309 | ||
| Advance Directives | 309 | ||
| TUBE FEEDING | 309 | ||
| Enteral Nutrition | 310 | ||
| Nasogastric Tubes | 310 | ||
| Gastrostomy and Jejunostomy Tubes | 310 | ||
| Parenteral Nutrition | 310 | ||
| reasons for TUBE FEEDING | 311 | ||
| WEANING FROM FEEDING TUBES | 313 | ||
| ASPIRATION PNEUMONIA | 314 | ||
| Risk Factors | 315 | ||
| NONMEDICAL RISKS AND BENEFITS | 315 | ||
| Nonmedical Benefits | 316 | ||
| Nonmedical Risks | 316 | ||
| ETHICAL DILEMMAS | 316 | ||
| ETHICAL DILEMMAS | 318 | ||
| TAKE HOME NOTES | 319 | ||
| References | 319 | ||
| Index | 323 | ||
| A | 323 | ||
| B | 323 | ||
| C | 324 | ||
| D | 325 | ||
| E | 326 | ||
| F | 326 | ||
| G | 327 | ||
| H | 327 | ||
| I | 328 | ||
| J | 329 | ||
| L | 329 | ||
| M | 329 | ||
| N | 330 | ||
| O | 331 | ||
| P | 331 | ||
| Q | 332 | ||
| R | 332 | ||
| S | 333 | ||
| T | 335 | ||
| U | 336 | ||
| V | 336 | ||
| W | 336 | ||
| X | 336 | ||
| Z | 336 |